Healthcare Provider Details

I. General information

NPI: 1326118910
Provider Name (Legal Business Name): GIANCARLO SCALISE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ # 142
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

4400 ALMA AVE
CASTRO VALLEY CA
94546-3104
US

V. Phone/Fax

Practice location:
  • Phone: 773-327-2800
  • Fax:
Mailing address:
  • Phone: 510-537-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number070012363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: